Healthcare Provider Details

I. General information

NPI: 1912679127
Provider Name (Legal Business Name): MATTHEW SNYDER MSW, LICSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 11/09/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 N CALDWELL ST APT 537
CHARLOTTE NC
28206-3686
US

IV. Provider business mailing address

PO BOX 18312
CHARLOTTE NC
28218-0312
US

V. Phone/Fax

Practice location:
  • Phone: 704-251-9666
  • Fax:
Mailing address:
  • Phone: 704-251-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number225170
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: